This section aims to examine Medicare as the financial and operational centre of Canada's public health care system. The different sections include a look into the quality of care both within Canada and internationally, the funding and financing of health care, and the role of the private sector within a predominantly public system. Below is an introductory explanation of Medicare, the Canada Health Act, and a general description of who and what is covered in this system.

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Financing and Federal Spending

Private Sector

What is Medicare?

Medicare refers to Canada's health care system through which residents can access publicly funded, medically necessary services. Rather than one national plan, medicare functions through thirteen provincial and territorial health care insurance plans concerned with health care management, organization and delivery. The federal government is tasked with setting and administering national standards of care, providing funding support, assisting the delivery of care for specific groups, including Indigenous communities, and contributing to a few other related matters such as research, specific tax credits, and regulation. Funding is provided to the provinces and territories through federal transfers.

Canada Health Act, 1984

The Canada Health Act, 1984, defines the national standards promoted by the federal government in provincial and territorial plans, characterized by five core principles:

Public administration: plans must be administered and operated on a non-profit basis by a public authority.
Comprehensiveness: plans must insure all medically necessary services provided by hospitals, physicians, and, in some instances, dentists.
Universality: plans must cover all residents.
Portability: plans must cover all residents when they travel within Canada and allow them to use their original health insurance for three months after moving to a new province or territory with limited coverage also required for travel outside the country.
Accessibility: plans must provide all residents reasonable access to medically necessary services based on medical need rather than the ability to pay.

Though the provinces and territories have the capacity to decide for themselves what is medically necessary, they must adhere to the principles of the Canada Health Act to be eligible for the Canada Health Transfer. If the federal government finds a province to be acting against the CHA or engaging in extra-billing, they can deduct payments from the CHT or impose penalties.

What's Covered?

Infographic provided by Health Canada illustrating the principles and criteria of the CHA.

As per the Canada Health Act, the federal government covers all medically necessary hospital and physician services via transfers to the provinces. The federal government also covers medically necessary dental procedures, so long as they are performed at a hospital by a hospital dentist. The Canada Health Act does not cover ambulance fees and assisted living (homecare) costs. Insurance plans may cover these services for certain groups of people, but their coverage is not guaranteed.

When understanding what the federal government covers, it is also important to understand who the federal government covers. The federal government provides healthcare directly to certain groups of people. This includes Indigenous peoples living on reserves, Inuit peoples, members of the Canadian Forces, some veterans, those in federal penitentiaries, and some refugee claimants. The federal government is involved in supporting healthcare research and disease monitoring and prevention.

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